Anus, Rectum, and Prostate
Examination
Have patient in knee-chest or left lateral position with hips and knees flexed, or standing with hips flexed and upper body supported by examining table. Females: Examination usually performed with patient in lithotomy position. Drape patient appropriately.
| Technique | Findings |
| Wear gloves on both hands | |
| Inspect and palpate sacrococcygeal and perianal area | |
| EXPECTED: Smooth and uninterrupted. | |
| UNEXPECTED: Lumps, rashes, tenderness, inflammation, excoriation, pilonidal dimpling, or tufts of hair. | |
| Inspect anus | |
| Spread patient’s buttocks.Examine, using penlight or lamp if needed, with patient relaxed, as well as with patient bearing down. | |
| EXPECTED: Skin coarser and darker than on buttocks. | |
| UNEXPECTED: Skin lesions, skin tags or warts, external or internal hemorrhoids, fissures and fistulas, rectal prolapse, or polyps. | |
| Inspect, palpate, assess sphincter tone | |
| Put water-soluble lubricant on index or middle finger; press pad against anal opening, and ask patient to bear down to relax external sphincter. As relaxation occurs, slip tip of finger into anal canal, as shown in figure below. (Assure patient that although he or she may feel the urgency of a bowel movement, it will not occur.) Ask patient to tighten external sphincter around finger. | EXPECTED: Even sphincter tightening. |
| UNEXPECTED: Patient discomfort. Lax or extremely tight sphincter, tenderness. | |
| Palpate muscular anal ring | |
| Rotate finger. | EXPECTED: Smooth, even with consistent pressure exerted. |
| UNEXPECTED: Nodules or other irregularities. | |
| Palpate lateral and posterior rectal walls | |
| Insert finger farther and rotate to palpate lateral, then posterior, rectal walls. If helpful, perform bidigital palpation with thumb and finger by lightly pressing thumb against perianal tissue and bringing finger toward thumb. | EXPECTED: Smooth, even, uninterrupted. |
| UNEXPECTED: Nodules, masses, polyps, tenderness, or irregularities. (Internal hemorrhoids not ordinarily felt unless thrombosed.) | |
 | |
| Males: Palpate posterior surface of prostate gland through anterior rectal wall | |
| Rotate finger and palpate anterior rectal wall and posterior surface of prostate gland. Alert patient that he may feel urge to urinate but will not. | |
| EXPECTED: Smooth, even, uninterrupted. | |
| UNEXPECTED: Nodules, masses, polyps, tenderness, or irregularities. | |
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